title: Predictors of visual outcome following surgical resection of medial sphenoid wing meningiomas.
abstract: Objective Medial sphenoid wing meningiomas (SWMs) are relatively common tumors that are associated with significant morbidity and mortality, primarily from their anatomic proximity to many critical neurological and vascular structures. A major complication is visual deterioration. This study aimed to identify predictors of visual outcome following medial SWM resection. Design Retrospective, stepwise multivariate proportional hazards regression analysis. Setting Johns Hopkins Hospital. Participants All patients who underwent medial SWM resection from 1998 to 2009. Main Outcome Measures Visual function. Results Sixty-five medial SWM resections were performed. After multivariate proportional hazards regression analysis, preoperative visual decline (relative risk [RR] 95% confidence interval [CI]; 13.431 [2.601 to 46.077], p = 0.006), subtotal resection (RR [95% CI]; 3.717 [1.204 to 13.889], p = 0.02), and repeat surgery (RR [95% CI]; 5.681 [1.278 to 19.802], p = 0.03) were found to be independent predictors of visual decline at last follow-up. Tumor recurrence and postoperative radiation therapy trended toward, but did not reach statistical significance. Conclusion These findings advocate for early and aggressive surgical intervention for patients with medial SWMs to maximize the likelihood of subsequent visual preservation. This may provide patients and physicians with prognostic information that may guide medical and surgical therapy for patients with medial SWMs.
authors.affiliation: Department of Neurosurgery, Brain Tumor Surgery Program, Johns Hopkins Hospital, Baltimore, Maryland, United States.
authors.forename: Kaisorn L
authors.initials: KL
authors.lastname: Chaichana
authors.forename: Christopher
authors.initials: C
authors.lastname: Jackson
authors.forename: Amar
authors.initials: A
authors.lastname: Patel
authors.forename: Neil R
authors.initials: NR
authors.lastname: Miller
authors.forename: Prem
authors.initials: P
authors.lastname: Subramanian
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.forename: Gary
authors.initials: G
authors.lastname: Gallia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.forename: Jon
authors.initials: J
authors.lastname: Weingart
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
keywords: meningioma; outcomes; risk factors; sphenoid wing; vision loss